The Role of Profit in Diabetes Care: A Force For Good or Evil?

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I just got a response to my previous post about the ADA Scientific Sessions  that I thought would be worth reposting here and responding to, since I know it’s an issue that lurks beneath the surface in many conversations about pharmaceutical companies and diabetes. 

Here’s the comment: 

“I have been diabetic since I was 1, and my twin 15 year old boys got it when they were 8. It makes me sick to my stomach to read your posts and you sending praise to companies that are in business simply to manage the disease and not cure it. Let’s get something clear right here and now; it’s in their best interest never to find a cure. It amazes me the ignorance of bloggers like you and your colleagues glorifying the same companies that make money every time an a1c is over 7. Maybe the reason for such glorification is the fact these same companies pay you to be there. Let’s face it, diabetes is the catalyst for all major diseases from kidney failure to heart disease. There is no monetary advantage by any company to set aside funds to find a cure. Instead of glorifying the accomplishments of companies that profit from the management of diabetes why don’t you ask the real questions: ‘How much money will you lose if there is a cure for diabetes?'”

My response: 

Brenpat, 

Thanks for your comment. It’s a useful perspective, though I must respectfully disagree with you (and point out that no pharma company paid for me to attend!). 

Yes, companies make money off of diabetes products. And yes, one could cynically say that it would not be in their best interest to cure all of their would-be customers. 

However, I think that pragmatism and realism show that this is not actually a concern, and that the potential profitability of diabetes products is a boon to people with diabetes, rather than a hindrance. 

First, what is so wrong with a profit motive?  If there were no money to be made from improving the lives of people with diabetes, then where, exactly, would funding for research and development come from? (And how would companies attract investors for their products were it not for the potential to make money?) The JDRF itself is in partnership with many of these companies, and they are working together to find better treatments and, yes, a cure. I think the heads of JDRF and ADA themselves — not to mention researchers desperate for funding — would be quick to say that money from industry is essential for fast progress. 

Second, let’s be realistic here for a second: there are more than 300 million people around the world with Type 1 or Type 2 diabetes and the number is rising. Even if a cure were developed tomorrow, it would be years before it could be provided to all the people who would need it. From a cynical/purely money-minded perspective, a cure would therefore be a huge boon to a company that discovered it: a strong market of people who are desperate for the cure (and are willing to pay through the nose for it) and a remaining group of people — numbering in the hundreds of millions — who would still be using the companies’ other drugs and supplies until they got access to what would no doubt be a quite expensive treatment. 

I also must say that I am speaking here from the perspective of having actually met some of the people who are involved in this research and in the development (and, yes, sales) of these products and drugs. They are not cynical. They are passionate. The people I have met truly want to help. As I say in my post, I’m fine with cynicism directed toward insurance providers (like those, for example, who will only cover CGMs if your A1c is OVER a certain percent, and drop coverage if you successfully use the CGM to lower it). But I watched a man from Johnson & Johnson — who had no previous connection to diabetes — choke up as he described watching his first pump start. I spoke to numerous doctors and researchers, affiliated with pharma companies, whose eyes lit up as they spoke about the developments they are working on. (For example: a pediatric endocrinologist, employed by J&J to work on the artificial pancreas project, speak about how frustrated he had been by his private practice — years of seeing children and families to whom he couldn’t offer anything but a hug — and how eager he was to become more actively involved in creating a product that would actually improve their everyday lives.) I had an hour-long conversation yesterday with Terry Gregg, former head of Minimed and current CEO of Dexcom, about his hopes and dreams for the future of diabetes care and his commitment to donating his own personal money toward diabetes research (you might be interested to know that Dexcom, maker of one of the USA’s only two CGM systems, is not yet profitable). I felt the excitement of the Chief Scientific Officer of Novo Nordisk when he spoke about the work they’re doing to see if the oral insulin they’re developing might possibly be able to prevent Type 1.  Yes, there are no doubt some purely profit-minded people in the bunch — and of course profit is a huge motivator in the field — but that is not the general feeling of the people I met.  I think that your comments would be quite insulting to the many people who have devoted their lives to improving the lives of people like you and me. 

Also worth noting: diabetes is an extremely complicated autoimmune disease, the intricacies of which we don’t yet fully understand. There were 18,000 attendees at this weekend’s Scientific Sessions. They are working on a cure. But it doesn’t exist yet. In the meantime, I will take any relief I can get. 

And last, I’d like to leave you with a question: where would you or I — or your sons — be if Lilly and other companies like it had not seen the market potential of artificial insulin? 

I, for one, prefer not to think of it.  

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Comments (3)

  1. Michael Aviad at

    Catherine. Thanks for this post.
    It’s also worth saying that Pharma companies are spending huge amounts on cure research (Novo Nordisk being the second largest funder of such research after the U.S government).

  2. Moira at

    As I heard someone say recently: Why should we have to choose between better treatments and a cure? Why can’t we have both?”
    I work hard every day to raise money for a cure — but I also so appreciate the breakthroughts that have come and are coming. I said this last night when I spoke at a diabetes event: What if when Banting and Best discovered insulin we said ‘Nothing else will do but a cure.?” We would not have glucagon. Or all kinds of different acting insulins. Or meters. Or strips covered by insurance. Or CGM’s. Or better treatments for eye disease.
    We’ve made progress. And if profit has come with it, so be it.

  3. What a great, insightful post, Catherine! I completely agree with you, that it’s not about the cynicism but about the people who are behind these companies and doing what they do. The other observation is how SO MANY of the executive-level individuals have personal diabetes connections, whether it’s themselves or a child or family member. If we truly want to question their motives, I think that speaks more to their hopes and desires in running these business aspects than the cynical arguments that they’re purely profit-driven and couldn’t care less about curing diabetes simply because of revenue. Not the case. Thanks for this.

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